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Increasing the amount of physical activity that you do cuts the risk of dementia by as much as 60%, when combined with a healthy lifestyle which includes cutting out nicotine and and cutting down on alcohol.

Recent research now explains that exerciseis the key to ageing successfully because physical activity keeps your brain healthy. A 2015 study reveals that older adults (their participants were Japanese men aged 60 to 74 years) are more likely to use the same part of the brain for tasks requiring cognitive control (such as the Stroop test — you can try it here) as young adults if they are physically fitter; those with less fitness use more parts of their brain to perform the same task. Another 2015 study also finds that brain atrophy can be reversed among healthy older adults and those with mild cognitive impairment (MCI) through moderate intensity exercise.

But exercise is only half the equation. It’s also important to give your brain opportunities to grow new neural connections. The notion that healthy ageing involves giving yourself cognitively demanding tasks (see our earlier blog post) gets more support from a 2016 study. Building on earlier findings, this study demonstrates that mentally challenging activities – such as learning digital photography or quilting or learning both – produces greater improvements in memory than low hanging fruit, like travel and cooking activities for which participants are not required to learn something new.

It doesn’t do any harm to also increase healthy foods, specifically green vegetables, walnuts, curries, and omega-3 foods like eggs, bananas, dark chocolate, avocado, and blueberries, which have been found to reduce the risk of cognitive decline with age.

But it might surprise you to find out that social connections also have a powerful effect on your health. A 2016 study finds that having a larger social network is crucial for health during late, as well as early, adulthood. Seniors not in social isolation achieve better scores on health markers which include blood pressure, body mass index, and a measure of systemic inflammation.

And that your beliefs about ageing can also be impactful. A 2015 study finds that people who hold negative beliefs (e.g., “elderly people are decrepit”) are more likely to subsequently experience brain changes associated with Alzheimer’s dementia.

According to the 2013 Well-being of the Singapore Elderly (WiSE) study, 1 in 10 persons in Singapore aged 60 years and above has dementia, which according to the WHO definition, is a “syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities”.

To suggest that someone with dementia “may” have memory loss, is misleading. Dementia is a condition in which people with dementia encounter problems with memory. But it is of course worth noting that the “symptoms of dementia are not limited to forgetfulness and memory loss“, as the author of this 2015 Institute of Policy Studies (IPS) Commons article points out. The ability to plan and make decisions, as well as solve problems, are other cognitive difficulties faced by someone with dementia.

Recent research efforts offer relatively quicker ways for clinicians to diagnose dementia and identify individuals at risk for dementia. According to a recent study published in 2015, researchers have developed a brief questionnaire, known as the QDRS comprising 10 items, which can accurately identify if someone has very mild, mild, moderate, or severe dementia. And a 2014 study has found a time-efficient method for identifying those at risk for dementia — through their ability to track a moving target with a computer mouse which moves in the opposite direction to what they see on the screen. Those diagnosed with Mild Cognitive Impairment (MCI) (and who are at risk for dementia) made many more errors than the control group. A more recent study also points to the tendency for those with amyloid plaques associated with dementia to have walk at a slower pace compared to healthy peers.

But you’re concerned that you may be developing dementia. Or you’re concerned about someone you know being at risk for dementia…

So here are 3 questions to answer:

1. Have you noticed any of these early warning signs?

The local Health Promotion Board has a print-friendly fact sheet, while the local Alzheimer’s Disease Association offers a checklist and describes the stages of dementia. No? Move on to Question 2!

2. Are you aware that you have difficulties remembering things?

A recent study which tracked over 2,000 individuals for 10 years reported that awareness of memory problems is a good clue as to whether they have dementia or not. In this study, those who were eventually diagnosed with dementia stopped being aware of their memory problems about 2.5 years before showing signs of dementia. So being aware that you have memory problems is actually a good thing. But read on…

3. How often do you have problems remembering things?

The US Alzheimer’s Association distinguishes behaviours which are characteristic of dementia from behaviours associated with healthy ageing in their list of early warning signs. Forgetting the names of things and/or the names of people is something that happens to most of us. Some of us experience the tip-of-the-tongue phenomenon quite often in fact. We can also be prone to forgetting appointments. But we’re usually able to retrieve these words and/or names later on, and we typically realise that we missed an appointment at a later time.

But a 2014 study also found that those who reported a change (more difficulties) in their ability to remember things were much more likely to subsequently develop dementia. So if you’re concerned that you might have cognitive issues, you can take an online assessment — Self-Administered Gerocognitive Exam or the SAGE test. But it’s also important that you consult with a medical professional if memory and thinking problems are a concern for you.

According to a recent study, 1 in 10 people above the age of 60 years in Singapore has dementia, which is a “syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities” (WHO).

If someone were to ask you how you can prevent dementia, you might be tempted to say that an active brain is the answer. Challenging your brain to do something difficult like learn a new language, dance, sport, or musical instrument does delay the symptoms of dementia by several years, but it may not lower your risk of dementia. A 2015 study found that those who had cognitively demanding jobs were less likely to show signs of dementia at the age of 75 years and above, and another recent study found that bilinguals were less likely to show signs of dementia compared to monolinguals, while earlier studies have already shown that learning to master something that you’re not already expert at, such as mahjong or tai chi, improves your cognitive skills if you have mild dementia.

So what causes dementia?

That’s not an easy question to answer. But research in the last decade has identified what makes it more likely for us to develop dementia.

Having diabetes increases our risk. A 12-year-long 2015 study conducted in Taiwan has found that individuals with diabetes have a higher risk of dementia, and that risk increases further with diabetes complications such as blindness and kidney failure.

But it’s not just diabetes. In fact, research shows that the factors which put us at risk for cardiovascular disease leading to heart attacks and strokes — alcohol consumption, smoking, and obesity — are also risk factors for dementia. Research shows that as many as 50% of people have dementia because of known risk factors such as physical inactivity, depression, smoking, mid-life hypertension, mid-life obesity, and diabetes.

So what lowers our risk?

The answer is exercise. One study estimates that physical inactivity is the reason for over 20% of the population to havedementia in US, UK, and Europe, while a 2013 study found that the risk of dementia at age 85 to 94 was 60% lower for men who maintained 4 out of 5 healthy lifestyle habits (regular exercise, not smoking, a low body weight, a healthy diet, and low alcohol intake) than those without these habits (with exercise being the main cause for lowering the risk of dementia).

But what if we’re already doing all those things. We exercise the recommended number of hours a week, if not more, and we don’t smoke…our BMI is within the healthy range and our lifelong goal is pursuing a wonderful diet of fruits and vegetables.

What else can we do to prevent cognitive decline? Here are few things we can do…

1. Spend less time sitting down because a 2015 study found that the more we sat down, the higher our chance of heart disease, obesity, and diabetes (…and dementia).

2. Get a creative hobby because a recent study which followed older adults for 4 years found that those active in arts and craft were less likely to experience cognitive decline.

3. Spice up your food because a recent study found that a once-a-week intake of chilli lowered the rate of cancers, respiratory diseases, and ischemic heart disease. The authors didn’t report its effects on dementia though. Instead, spice in the form of tumeric (curcumin) has been found to be useful for repairing brain cells affected by dementia.

4. Eat leafy green vegetables because a 2015 study found that cognitive decline was slower among those who regularly ate spinach, kale, collards, and mustard greens. And go easy on the meat and cheese (Why? Read this article on the Blue Zones to learn more).

5. Increase your intake of walnuts because a new study suggests that they delay the progression of Alzheimers.

6. Incorporate eggs, bananas, dark chocolate, avocado, blueberries, and omega-3-rich foodsinto your diet because a collection of studies show that omega-3 fatty acids, choline, magnesium, and cocoa flavanols are among the nutrients which support brain functioning.

There are 6 easy steps to support brain functioning and delay cognitive decline, but preventing dementia requires regular exercise, a diet of vegetables, fruits, and no tobacco, good control of blood sugars, and good mental well-being. No one said it’d be easy…

It was recently reported that tip-of-the-tongue phenomena isn’t something that we need to worry excessively about.

It appears that older people have the experience of not being able to identify someone famous or find the name of something more frequently than younger people (“Tip-of-the-Tongue Moments May be Benign“, American Psychological Science, 16 Oct 2013). But it has been found to be unrelated to cognitive changes associated with onset of dementia, suggesting that we shouldn’t be too concerned when we can’t name an actor in the midst of our frenetic discussion of the current k-drama series during family reunion dinners.

In contrast, there are other signs which we should be paying attention to. The Agency for Healthcare Research and Quality (US) for example lists a number of symptoms which might indicate dementia, which include experiencing increased difficulty remembering recent conversations and appointments, performing complex tasks which involve a number of steps, orienting and finding one’s way to familiar places. The Alzheimer’s Association (US) lists 10 symptoms which distinguishes the signs that someone may have Alzheimer’s from that of typical age-related cognitive changes. Given that dementia is a progressive condition, where there is “deterioration in memory, thinking, behaviour and the ability to perform everyday activities” (WHO), these early stage signs serve as a useful guide. The tendency to confuse time and place, resulting in one going to an appointment at the wrong time or at the wrong place, is another such sign – mentioned here by the Health Promotion Board.

There is also much talk about a scan which may determine if one’s cognitive difficulties are caused by Alzheimer’s disease (“Alzheimer’s Anxiety“, NY Times, 16 Nov 2013). But perhaps more pressing for most of us is the issue of whether we’re experiencing cognitive difficulties which warrant a closer look. And the answer to that might just be in a 12-question pen-and-paper questionnaire (known as the SAGE) which has been found useful for discerning cognitive decline, and for which validity research findings were recently published in the Journal of Neuropsychiatry and Clinical Neurosciences and reported in this article in Forbes (14 Jan 2014).